title: Pyloric exclusion in the treatment of severe duodenal injuries: results from the National Trauma Data Bank.
abstract: Pyloric exclusion (PEX) has traditionally been used in the management of complicated duodenal injuries to temporarily protect the duodenal repair and prevent septic abdominal complications. We used the American College of Surgeons National Trauma Data Bank (v 5.0) to evaluate adult patients with severe duodenal injuries [American Association for the Surgery of Trauma (AAST) Grade > or = 3] undergoing primary repair only or repair with PEX within 24 hours of admission. Propensity scoring was used to adjust for relevant confounding factors during outcomes comparison. Among 147 patients with severe duodenal injuries, 28 (19.0%) underwent PEX [15.9% (11/69) Grade III vs 34.0% (17/50) Grade IV-V]. Despite similar demographics, PEX was associated with a longer mean hospital stay (32.2 vs 22.2 days, P = 0.003) and was not associated with a mortality benefit. There was a trend toward increased development of septic abdominal complications (intra-abdominal abscess, wound infection, or dehiscence) with PEX that was not statistically significant. After multivariable analysis using propensity score, no statistically significant differences in mortality or occurrence of septic abdominal complications was noted between those patients undergoing primary repair only or PEX. The use of PEX in patients with severe duodenal injuries may contribute to longer hospital stay and confers no survival or outcome benefit.
authors.affiliation: Los Angeles County Hospital/University of Southern California School of Medicine, Los Angeles, California 90033-4525, USA. jdubose@surgery.usc.edu
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: DuBose
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Pedro G R
authors.initials: PG
authors.lastname: Teixeira
authors.forename: Anthony
authors.initials: A
authors.lastname: Shiflett
authors.forename: Bradley
authors.initials: B
authors.lastname: Putty
authors.forename: D J
authors.initials: DJ
authors.lastname: Green
authors.forename: David
authors.initials: D
authors.lastname: Plurad
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004386:Duodenum / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011708:Pylorus / Q000601:surgery*; D012042:Registries / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D015996:Survival Rate; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*